< International Circulation>: Would you please expand on the progress and current views about the use of ARB agents in hypertension patients with prediabetes?

  《国际循环》：能否谈谈ARBs药物在高血压合并前趋糖尿病合患者的应用进展及现状？

     Prof Thomas Unger: I think when a patient has hypertension and is somewhat prone to have diabetes or is pre-diabetic the ARBs or sartans are certainly the number one drugs to treat hypertension because they have this additional metabolic effects. They can improve insulin sensitivity in many cases and if you look at the meta-analysis by Elliot and Meyer whom showed that when they compared different classes of anti-hypertensive drug classes that the ARBs do best at preventing new onset diabetes and I think this comes out in many studies. For example the LIFE Trial against a beta blocker but also in the VALUE Trial and In the CHARM Trial and even if you take the ONTARGET and  TRANSCEND Trials; if you take them together with PROFESS which was also a telmisartan trial for strokes then you can still see a 16% significant reduction for new onset diabetes. Most of the sartans do a good job in preventing new onset diabetes.

    Unger教授：我认为高血压合并前趋糖尿病合患者可以使用ARBs或沙坦类药物，因为它们不但可以降血压还能调节糖脂代谢。大多情况下这类药物可以提高胰岛素的敏感性。Elliot 和Meyer对各类抗血压药进行meta-分析发现ARBs类药物是预防糖尿病的最佳药物，我想这和许多分析结果是一致的，比如对β受体阻滞剂的LIFE分析、VALUE分析和CHARM分析甚至是ONTARGET 和TRANSCED分析；如果将这些分析方法综合起来分析替米沙坦预防中风的效果，你可以发现其可显著减少16%的糖尿病的发生。大多数沙坦类药物可以很好的预防此类糖尿病的发生。